AFTERWARDS, DON’T LOSE HEART
Heart attacks are the great thieves of men’s health. Not only can they creep tip and rob a man of his physical health but they can also steal his confidence and psychological wellbeing. Because they strike directly at the centre of his being, they can leave him vulnerable and insecure.
After a heart attack, many men can overcome the physical loss of heart function but are defeated by the psychological ‘loss of heart’. They feel depressed and hopeless, and believe they will never regain their former condition. Commonly, they are bereft, mourning for their former selves.
The consequences of becoming trapped in such despair can be devastating. Studies have shown that men who do not emerge from this state lay themselves open to a subsequent attack.
The gloomy post-attack period is characterised by loss. The first thing lost is a sense of immortality. Men feel under threat of another heart attack and threat of death. They have lost a portion of their heart and, with that, a portion of their health.
Many men also fear they have lost standing in society and imagine they will be neglected or tossed onto the scrap heap. It is believed, for example, that when employers are casting around for retrenchments, they are likely to chose employees who don’t look promising in the long term.
Some men also describe a loss of position at home. Before the heart attack, they supported and provided for the family from a position of strength. Afterwards, there may be a role reversal and they may feel badly about it.
Younger men are more likely than older men to become depressed and anxious after a heart attack because they usually have more responsibility and more to lose. If they slide deeper into hopelessness, their recovery will be impaired: they will stop looking after themselves and let habits slip. They may sit and brood, eat, start smoking again, drink, get fat and become increasingly isolated. The unhappiness and inertia can become self-perpetuating, increasing the chances of a second heart attack. By intervening early, telling men what to expect and confirming their initial responses, health workers can halt this downward spiral.
Men’s usual first reaction to a heart attack is to deny the event and imagine they are not unwell. Next they accept the diagnosis and understandably become anxious about the outcome. Around the time they go home, they have a sense of gloom about their real and imagined losses. Happily, the next response is adjustment and acceptance, which means they are on the way to recovery It is important for men to understand that the changes in mood they experience are normal and are not a direct product of the heart attack but part of the process of recovery. Eventually they tuck away in the back of their minds the fact that they have had a heart attack and get on with their lives.
Psychological recovery follows physical recovery, but many men think the perpetuation of psychological symptoms implies they have not recovered physically. It is usual for men to recover to the point where they are completely unaware of the loss of heart function and are able to conduct a normal life.
Physical recovery usually takes about 3 to 6 weeks, while psychological recovery takes about 6 months. The best way to recover is to join a rehabilitation group and discuss issues and concerns with others going through similar experiences. Studies comparing people who attend groups with those who receive standard medical care (discharge from hospital followed by visits to a local doctor) repeatedly show that members of groups are fitter, are psychologically, socially and sexually better off, are more likely to resume work and have an improved ability to readjust to their occupations.
Long-term studies show that these men also have fewer recurrent heart attacks and are less likely to need angioplasty or bypass surgery. There is a 20 to 25 per cent reduction in mortality among those who attend groups. Men shouldn’t let the word ‘rehabilitation’ put them off. The groups don’t just offer physical and psychological conditioning; they offer secondary prevention. Rehabilitation does more than get men back on track; it gets them back onto a better track.
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